The trial of a former director of nurses at a care facility continued Thursday with testimony from doctors, an investigator and the nurse who taught incoming students at the care center.
Deputy Attorney General Steven Muni called Dr. Frank B. Housel as his first witness of the day for the Donna Palmer trial’s second day. Housel, who specializes in emergency medicine, saw Johnnie Esco on March 6, 2008. He said that she had a distended, tender abdomen — putting pressure anywhere on her abdomen caused her to moan — and she looked “uncomfortable.” He noted decreased bowel sounds.
Esco’s white blood cell count was 27,000. A count of 4,000 to 11,000 is normal, and the high count indicated an infection. He noted there was an obstruction in the colon — his main concern — along with a large amount of stool.
He called the general surgeon and ordered a CAT scan. Esco’s rectum was dilated to 10 cm, or about 4 inches. A blood clot was found in her left leg. She had an abdominal aneurysm. The radiologist found a clot or scarring in her right lung — Esco survived lung cancer earlier in her life. Pill fragments were found in her colon. Though he couldn’t give a time frame, Housel told Muni it was possible that it had taken several days to build that amount of stool in her colon.
After Housel was excused with no questions from defense attorney Patrick Hanly, the attorneys argued out of the jury’s presence over evidence. Muni wanted Dr. Kathryn Locatell, who was present at Esco’s autopsy, to speak about it. However, Hanly pointed out, this would only play at the jury’s sympathies, much as the pulling-the-wig-off stunt from the previous day did. In the end, Judge Daniel B. Proud went with his original ruling before the trial began — no mentioning of the autopsy or Esco’s death to the jury.
Next to the stand was Debra Gard, a Department of Justice special agent who investigated the case. She noted there was no internal document at the El Dorado Care Facility regarding elder abuse and Esco, as an interdisciplinary committee made of various nurses from the facility had found no abuse committed. Gard also agreed that the charts for Esco did not make sense. Non-standardized notation had been used.
Under Hanly’s questioning, Gard revealed an inconsistency by Donna Eileen Pielin, a nurse working under Palmer. Pielin had not mentioned calling Palmer regarding transferring Esco to Marshall Hospital. This inconsistency was a topic from the previous day’s hearing, and Gard confirmed that Pielin had been inconsistent in what she said during interviews. She confirmed Pielin hindered the investigation, but was not charged with obstruction of justice. She noted that Palmer had given options to Pielin, as Pielin testified ordering the transfer order to be rescinded.
Meanwhile, staff of Marshall were also not charged with anything, nor was there an investigation into care of Esco at the hospital in regards to possible abuse.
Back under Muni’s questioning, he handed her a document showing when it was reported that Esco had bruises, a missing ring and torn skin from her pinkie finger, where the ring was. “Holy cow, April,” Gard said, noting that the document was filed a month after the incident. The cause of the injuries remained unknown. The ring was found and returned to Johnnie’s husband, Don, however. Gard agreed with Hanly that the investigation by EDCC into the injuries was only completed in April, not started, but she was surprised how long it took to complete.
Nurse takes the stand
Patricia Bach, a licensed vocational nurse and the director of staff development at EDCC at the time of the incident, was the next to take the witness stand. She taught the students that would become certified nursing assistants, who did a large amount of the floor work at the facility.
Permission was needed from Palmer to transfer patients, she testified, which Palmer said during a meeting. It was a well-known rule of the facility, she said. Only in a “dire emergency” was permission not needed.
Though not involved in the Esco case, Bach heard about the case later from Pielin. Pielin was upset, she said, and thought she was in trouble for lying to Gard. Pielin was afraid she would be fired. Bach told her that losing her job was better than losing her nursing license.
Bach stated her relationship with Palmer was “rocky … I felt intimidated by her,” though Palmer was not her boss.
She told Hanly that she was in charge of teaching the soon-to-be CNAs how to chart, but once they were out of her class, she held no responsibility over them. She testified, contrary to Pielin’s statements, that it would have been fairly easy to chart the phone conversation between Palmer and Pielin, as well as Dr. Amrit Singh at Marshall, regarding Esco’s transfer. She said they were trained to chart everything, agreeing with the nursing adage that if it wasn’t charted, it didn’t happen.
Palmer fired staff over disagreements before, she testified, but she felt that all the firings had been justified. “A lot deserved it,” she said of the fired CNAs. Normally, though, if someone was not performing up to standards, they would simply be sent back to her for more training.
The final witness of the day was Esco’s physician, Dr. Bradley Barnhill. Due to her moderate Alzheimer’s, he said, she only knew him as “the doctor from Texas” — something they bonded over as both were from the state. He noted she had chronic problems with constipation and had lived through lung cancer and heart disease.
He saw Esco on Feb. 28, 2008, and prescribed a regimen to keep her from being constipated. The next time he saw her, he said, she was “gravely ill.” She had a fever of 103 degrees, decreased response and a distended abdomen that was caused by a “pretty significant” fecal impaction. He said that 3 cm was the normal diameter of a rectum versus her 10 cm. Stool was throughout her colon, 4 or 5 feet, he said. Gas in the colon was consistent with impaction.
The stool had become solid, which would take “days, minimum,” to form, he said. He noted the overwhelming infection, and that she could have had “dead bowel” where the impaction causes loss of blood to the bowels, which would require extensive surgery to deal with the complications of the impaction. That would be high-risk for her, he said, as she would need blood thinners for her blood clot. But, a delay “could be devastating.”
He was never told of any bowel troubles of Esco, who he had as a patient with his practice outside the hospital, only receiving faxes about the injury to her finger.
He told Muni that Esco’s impaction was “one of the most severe” he had seen, if not the most severe.
She also had numerous pill fragments in her colon, more than would be considered normal.
All of the information together led him to believe the impaction could have taken between a couple of days to a week or two, he said.
Barnhill told Hanly that he had no concerns sending patients to EDCC, and confirmed that he sent more there after Esco’s case than before she was there. He said he did not file any abuse reports about the facility, confirming that he would have to if he suspected abuse, as he is a mandatory reporter. He said he had never had any problems with Palmer, winking at her while answering.
He said there was nothing on the interagency transfer sheet when Esco was transferred about disimpactions that occurred at Marshall or any constipation. He agreed it was unlikely that, contrary to the charts at EDCC, Esco had any “large” bowel movements while there.
Barnhill was excused and the jury let out for the day. The trial will continue on Nov. 12 at 8:30 a.m. in Department 2.
Palmer is accused of elder abuse following the death of Esco in 2008.
Contact Cole Mayer at 530-344-5068 or [email protected] Follow @CMayerMtDemo.